Stephen B Williams1, Jinhai Huo2, Karim Chamie3, Marc C Smaldone4, Christopher D Kosarek1, Justin E Fang1, Leslie A Ynalvez1, Simon P Kim5, Karen E Hoffman6, Sharon H Giordano2,7, Brian F Chapin8. 1. Division of Urology, The University of Texas Medical Branch, Galveston, Texas. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Urology, University of California-Los Angeles, Los Angeles, California. 4. Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania. 5. Department of Urology, Case Western Reserve University, Cleveland, Ohio. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 8. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P < .001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables. Cancer 2017;123:1617-1624.
BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival. RESULTS: Of 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P < .001). CONCLUSIONS: Population-based data indicated that patients with prostate cancer who received treatment with either surgery or radiotherapy had improved overall survival compared with a cohort of matched noncancer controls. Surgery produce longer survival compared with radiation therapy. These results suggest an inherent selection-bias because of unmeasured confounding variables. Cancer 2017;123:1617-1624.
Authors: Danil V Makarov; Bruce J Trock; Elizabeth B Humphreys; Leslie A Mangold; Patrick C Walsh; Jonathan I Epstein; Alan W Partin Journal: Urology Date: 2007-06 Impact factor: 2.649
Authors: James L Mohler; Philip W Kantoff; Andrew J Armstrong; Robert R Bahnson; Michael Cohen; Anthony Victor D'Amico; James A Eastham; Charles A Enke; Thomas A Farrington; Celestia S Higano; Eric Mark Horwitz; Christopher J Kane; Mark H Kawachi; Michael Kuettel; Timothy M Kuzel; Richard J Lee; Arnold W Malcolm; David Miller; Elizabeth R Plimack; Julio M Pow-Sang; David Raben; Sylvia Richey; Mack Roach; Eric Rohren; Stan Rosenfeld; Edward Schaeffer; Eric J Small; Guru Sonpavde; Sandy Srinivas; Cy Stein; Seth A Strope; Jonathan Tward; Dorothy A Shead; Maria Ho Journal: J Natl Compr Canc Netw Date: 2014-05 Impact factor: 11.908
Authors: Michel Bolla; Laurence Collette; Léo Blank; Padraig Warde; Jean Bernard Dubois; René-Olivier Mirimanoff; Guy Storme; Jacques Bernier; Abraham Kuten; Cora Sternberg; Johan Mattelaer; José Lopez Torecilla; J Rafael Pfeffer; Carmel Lino Cutajar; Alfredo Zurlo; Marianne Pierart Journal: Lancet Date: 2002-07-13 Impact factor: 79.321
Authors: Sharon H Giordano; Yong-Fang Kuo; Zhigang Duan; Gabriel N Hortobagyi; Jean Freeman; James S Goodwin Journal: Cancer Date: 2008-06 Impact factor: 6.860
Authors: Anna Bill-Axelson; Lars Holmberg; Hans Garmo; Jennifer R Rider; Kimmo Taari; Christer Busch; Stig Nordling; Michael Häggman; Swen-Olof Andersson; Anders Spångberg; Ove Andrén; Juni Palmgren; Gunnar Steineck; Hans-Olov Adami; Jan-Erik Johansson Journal: N Engl J Med Date: 2014-03-06 Impact factor: 91.245
Authors: Rishi Deka; Daniel R Simpson; Alex K Bryant; Vinit Nalawade; Rana McKay; J D Murphy; Brent S Rose Journal: JAMA Oncol Date: 2018-11-01 Impact factor: 31.777
Authors: Devin N Patel; Shalini Jha; Lauren E Howard; Christopher L Amling; William J Aronson; Matthew R Cooperberg; Christopher J Kane; Martha K Terris; Brian F Chapin; Stephen J Freedland Journal: Int J Urol Date: 2018-09-25 Impact factor: 3.369
Authors: Thomas L Jang; Neal Patel; Izak Faiena; Kushan D Radadia; Dirk F Moore; Sammy E Elsamra; Eric A Singer; Mark N Stein; James A Eastham; Peter T Scardino; Yong Lin; Isaac Y Kim; Grace L Lu-Yao Journal: Cancer Date: 2018-09-25 Impact factor: 6.860
Authors: Mikayla R Thompson; Jiangong Niu; Xiudong Lei; Malgorzata Nowakowska; Mackenzie R Wehner; Sharon H Giordano; Kevin T Nead Journal: Breast Cancer (Dove Med Press) Date: 2021-04-07